Newlin - Decision Support Function and QA Launch

The one-paragraph version. Decision Support is the firm's appeals engine. When a claim is denied (about 90 percent are, at the initial level), this small team calls the client, breaks the news, and runs a structured intake to file the reconsideration or hearing. It is almost entirely outbound: 2,748 outbound calls in three weeks against only 165 inbound. The work is a fixed, repeatable process done well, but it re-asks information the firm already has, it delivers hard news to already-anxious clients, and it runs into trust and data problems. That makes it a strong candidate for both a communications standard and partial automation.

1. What the team does (the function)

Decision Support is an outbound-led team. Its core job is not answering calls; it is proactively calling clients after a denial to keep the case moving. A typical call: reach the client, explain that the claim was denied and that this is normal, then run a standard appeal-intake questionnaire and file the reconsideration or request the hearing.

The appeal-intake call, step by step (what they run on every outbound)

Step	What happens
Reach and confirm	Reach the client, confirm identity (name, date of birth, last four)
Deliver the news	Explain the denial and reassure: denials at the initial level are common, here is what we do next
Verify the file	Confirm contact details, medications, medical facilities and providers
Run the questionnaire	Structured yes/no questions: condition changes, new diagnoses, new treatments, work and income, daily activities, education or vocational programs
Set the hearing preference	Telephone or video hearing, preferred contact method, and what to expect at the hearing

The shape of the work

Metric	Value (3 wk)
Outbound calls (the core work)	2,748 / 82 h
Inbound calls	165 / 25 h
Inbound that is appeal intake	45%
Calls that reach agent-and-client	94%
Calls resolved with information	78%

2. How the team performs today

What is already good. The intake process is structured and thorough. The best staff run the questionnaire cleanly and, crucially, reassure well: they tell a just-denied client that a denial at the initial level is normal (90 percent are denied), explain the reconsideration and hearing path, and describe how the hearing works and why approval odds improve there. For a scared client who just got bad news, that framing matters, and the team does it.

Where it breaks down

Re-asking what we already have. The intake re-verifies information the client has often given before. Clients push back audibly ("I am not doing this a third time," "you guys should already know what is going on"). The data does not flow between touches.
Trust and the offshore perception. This is a partly offshore team, and one reviewed client openly feared a scam because of accents and never being transferred to a lawyer, and disputed the fee. That is a real risk on outbound calls delivering bad news, and it needs a trust-building answer.
Defensiveness under complaint. When clients complain, some staff argue the record ("it shows you were offered...") instead of acknowledging and moving forward. De-escalation beats defending.
Wrong-number and bad-data outbound. Some outbound reaches the wrong or unfindable person, wasting the call and confusing the recipient. Contact-data quality directly costs this team.

3. The opportunities

1. Stop re-asking, pre-fill the intake

The appeal-intake questionnaire is fixed and repeatable. Pre-filling it from the file, or letting clients complete it by SMS or portal before the call, shortens calls and removes the biggest source of client frustration.

2. Partially automate a fixed process

Denial outreach is scripted and predictable. A portion can be automated (an SMS or portal appeal-intake flow the agent verifies), reducing repetitive outbound volume, honestly stated.

3. Build trust on the outbound call

Branded caller ID, a clear self-identification, and a real path to escalate to the firm would blunt the scam perception that surfaced. Clients receiving bad news need to trust the caller instantly.

4. Clean the contact data

Wrong-number and unfindable outbound wastes a small team's limited hours. A data-quality pass on the denial-outreach list pays for itself quickly.

4. Solutions

Start now No new technology required

Move	What it fixes
A denial-outreach standard: confirm you have the right person, deliver the denial with reassurance, then run the intake without re-asking what the file already shows.	Opportunity 1, client experience
De-escalation over defense: when a client is upset, acknowledge and act; never argue the record.	Trust
Clear self-identification and escalation: state the firm and your name, and offer a path to the firm when a client is uneasy.	Opportunity 3
Close-the-loop discipline on every promised follow-up.	Follow-through

Soon The structural and automation wins

Move	What it fixes
Pre-filled or self-service appeal intake (SMS or portal form the agent verifies) so the questionnaire is confirmation, not interrogation.	Opportunity 1, 2
Partial automation of denial outreach for the scripted portion, freeing the team for the calls that need a human.	Opportunity 2, FTE
Branded caller ID and a contact-data cleanup on the outreach list.	Opportunity 3, 4

5. Folding Decision Support into the QA journey

Decision Support uses the same seven-fundamental standard, adapted for an outbound-led team that delivers bad news. The open is different (we are calling them), and two facets are weighted heavily: delivering the denial with reassurance and de-escalation.

#	Fundamental	The standard (outbound)	QA check
1	Open (outbound)	State the firm and your name, and why you are calling	Did they identify the firm, themselves, and the reason?
2	Confirm the right person	Verify identity before any case detail	Verified before disclosing?
3	Deliver the news with reassurance	Explain the denial plainly and normalize it, with the path forward	Was the denial explained and reassured?
4	Run intake, do not interrogate	Confirm what the file shows; do not re-ask known information	Did they avoid re-asking known data?
5	Capture plus correct	Log answers accurately; read back changes	Captured and confirmed?
6	Close the loop	Recap the next step and the hearing path, warm close	Did they recap what happens next?
7	Rapport (scored)	Warmth and de-escalation, especially after bad news, never defensive	Scored low / medium / high

The human-in-the-loop model is the same as the other teams: the AI engine scores every call and flags exceptions (news delivered coldly, re-asking, defensiveness) for coaching and exemplars (a denial handled with warmth and clarity) for recognition and training. Humans review flagged and sampled calls, coach with the clip, verify follow-ups, and escalate the structural issues (data reuse, the trust perception). Orient first, then score, then hold accountable.

6. The immediate next moves

Finalize the denial-outreach and de-escalation standards and a one-page Communications Excellence sheet.
Turn on AI scoring for Decision Support, weighting the news-delivery and de-escalation facets.
Scope pre-filled or self-service appeal intake (SMS or portal) as the biggest lever on call length and client frustration.
Run a contact-data quality pass on the denial-outreach list to cut wrong-number outbound.